Provider Demographics
NPI:1255518015
Name:BROWN, THERESA YVETTE (ATC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:YVETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3713
Mailing Address - Country:US
Mailing Address - Phone:609-909-2666
Mailing Address - Fax:609-625-0043
Practice Address - Street 1:6283 HOLLY ST
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3713
Practice Address - Country:US
Practice Address - Phone:609-909-2666
Practice Address - Fax:609-625-0043
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001031002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer